Lancet Respiratory Medicine最新文献

{"title":"Respiratory infections due to human common cold coronaviruses, SARS-CoV, MERS-CoV, and SARS-CoV-2: epidemiology, pathogenesis, clinical features, diagnostics, therapeutics, and vaccine landscapes.","authors":"Alimuddin Zumla, David S Hui, Malik Peiris, Stanley Perlman","doi":"10.1016/S2213-2600(26)00049-4","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00049-4","url":null,"abstract":"<p><p>Over the past half-century, perceptions of human coronaviruses have evolved from their initial characterisation as causes of the common cold to recognition of their capacity to trigger severe disease and global epidemics. The emergence of three zoonotic coronaviruses-severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019, has had profound health, economic, and societal consequences and continues to influence global epidemic-preparedness strategies. All three viruses remain on the WHO Blueprint of priority pathogens for research and development. This Review summarises current knowledge on human coronaviruses, drawing lessons from the past 25 years of epidemic outbreaks. The shared and divergent features of SARS-CoV, MERS-CoV, and SARS-CoV-2, including their origins, evolution, transmission determinants, zoonotic transmission, viral entry pathways, pathogenesis, spectrum of clinical manifestations, long-term sequelae, and case-fatality profiles are highlighted. The full range of clinical manifestations, from asymptomatic or atypical presentations to severe acute respiratory and multisystem disease, are outlined together with risk factors for progression and populations with the greatest susceptibility. Diagnostic approaches, including molecular assays, antigen-based tests, and imaging modalities are described alongside current therapeutics, antiviral strategies, immunomodulators, supportive care principles, and evidence from clinical trials. Advances in diagnostics, vaccines, therapeutics, and infection-control practices are examined together with persistent challenges in early recognition, particularly in resource-limited settings. Strengthening multinational clinical trial capacity, leveraging digital innovations, and embedding One Health approaches are essential to mitigating spillover risks and improving global readiness. We review the latest data, identify gaps and opportunities, and outline forward-looking strategies to anticipate and prepare for the threat of future coronaviruses, and other existing or new respiratory pathogens with epidemic potential. Clinicians and other health-care workers play a central role in detecting and reporting possible lethal coronavirus infection including atypical presentations, enabling rapid, coordinated infection control and management responses.</p>","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilator-associated risk beyond PARDS: insights from PRoVENT-PED.","authors":"Luca Marchetto, Marco Daverio","doi":"10.1016/S2213-2600(26)00080-9","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00080-9","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Respir Med 2026; 14: 5-6.","authors":"","doi":"10.1016/S2213-2600(26)00093-7","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00093-7","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"14 5","pages":"e31"},"PeriodicalIF":32.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology, ventilation management, and clinical outcomes in children (PRoVENT-PED): first results from the 10-year, investigator-initiated, international, multicentre, prospective cohort study.","authors":"Relin van Vliet, Jonathan W J Melger, Reinout A Bem, Robert G T Blokpoel, Marcus J Schultz, Frederique Paulus, Martin C J Kneyber, David M P van Meenen","doi":"10.1016/S2213-2600(26)00044-5","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00044-5","url":null,"abstract":"<p><strong>Background: </strong>Evidence supporting lung-protective ventilation in children overwhelmingly stems from adult trials. This study aimed to assess the epidemiology, ventilation management, and outcomes across predefined age groups of invasively ventilated critically ill children with or without paediatric acute respiratory distress syndrome (PARDS), and to identify potentially modifiable factors associated with outcome.</p><p><strong>Methods: </strong>This 10-year, investigator-initiated, international, multicentre, observational prospective cohort study was conducted in 83 ICUs across 34 countries worldwide. Paediatric intensive care units were invited to participate in a registry. This phase of the study enrolled children (younger than 18 years) admitted to a participating centre who received invasive ventilation for at least 12 h. Preterm infants of a postconceptional age younger than 40 weeks and those receiving extracorporeal membrane oxygenation were excluded from participation. All data collected, including patient demographics, baseline characteristics, and ventilation data, were part of standard clinical care and retrieved from medical records. The primary outcome was 28-day intensive care unit (ICU) mortality. This study is registered at ClinicalTrials.gov (NCT06220825), the first phase of the study is completed, subsequent phases on different topics are currently running.</p><p><strong>Findings: </strong>1427 children (median age 24 months [IQR 7-96]; 799 [56%] were male and 628 [44%] were female) were enrolled between April 1, and June 30, 2024, and Oct 1, and Dec 31, 2024. PARDS was identified in 164 (11%) of 1427 children and occurred most frequently in preschool-aged children (aged 3 years to younger than 6 years). Ventilator management varied by age and PARDS status; decreased age and the presence of PARDS were associated with exposure to high airway pressures. 28-day ICU mortality was 14% (201 of 1427 children), and it was lowest in neonates (3 [3%] of 112 children) and higher in patients with PARDS than those without PARDS (44 [27%] of 164 vs 157 [12%] of 1263). Positive end-expiratory pressure (PEEP), driving pressure (ΔP) and fractional concentration of oxygen (FiO₂) were identified as potentially modifiable factors independently associated with ICU mortality.</p><p><strong>Interpretation: </strong>Ventilation management in children varies substantially by age and PARDS status. Among potentially modifiable ventilation factors, only PEEP, ΔP, and FiO₂ were associated with 28-day mortality.</p><p><strong>Funding: </strong>Amsterdam University Medical Centre and University Medical Centre Groningen.</p>","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azurocidin-1 as a mediator of bronchiectasis severity, epithelial defence, and target of dipeptidyl peptidase-1 inhibition: an international, multicohort study.","authors":"Amelia Shoemark, Emma D Johnson, Morven Shuttleworth, Max Schwiening, Rebecca Hull, Jamie Stobo, Hani Abo-Leyah, Simon Finch, Jennifer Pollock, Jeffrey T J Huang, Hollian Richardson, Lidia Perea, Eve McIntosh, Erin Cant, Rachel Galloway, Hayoung Choi, Anthony de Soyza, Arietta Spinou, Felix C Ringshausen, Natalie Lorent, Patrick Mallia, Sebastian L Johnston, Marek Gierlinski, Pieter Goeminne, Michael R Loebinger, Yong Hua Gao, Sanjay H Chotirmall, Raja Dhar, Charles Haworth, Josje Altenburg, Francesco Blasi, Eva Polverino, Michal Shteinberg, Sam Strickson, David Cipolla, Ariel Teper, Carlos Fernandez, Vivian H Shih, Kevin Mange, Aran Singanayagam, Stefano Aliberti, Oriol Sibila, Merete B Long, James D Chalmers","doi":"10.1016/S2213-2600(25)00334-0","DOIUrl":"https://doi.org/10.1016/S2213-2600(25)00334-0","url":null,"abstract":"<p><strong>Background: </strong>Dipeptidyl peptidase-1 (DPP1) inhibitors prevent the activation of neutrophil serine proteases and reduce exacerbations in people with bronchiectasis. We previously identified a novel effect of DPP1 inhibitors in reducing the neutrophil pseudoenzyme azurocidin-1 (AZU1). The aim of this study was to investigate the role of AZU1 in the pathophysiology of bronchiectasis.</p><p><strong>Methods: </strong>Sputum AZU1 concentrations were analysed in multiple cohorts. These consisted of two observational cohorts of patients with bronchiectasis (EMBARC BRIDGE cohort 1 and cohort 2) and a cohort of patients with chronic obstructive pulmonary disease (COPD; TARDIS COPD cohort) to correlate AZU1 with disease severity and exacerbations. A rhinovirus challenge study was used to investigate AZU1 concentrations during experimental exacerbation in COPD, people who smoke, and controls. A post-hoc analysis of the phase 2 WILLOW trial of brensocatib versus placebo was used to assess the effect of DPP1 inhibition on airway AZU1.</p><p><strong>Findings: </strong>Higher AZU1 sputum concentration was associated with increased bronchiectasis disease severity index (p<0·0001), decreased percentage predicted forced expiratory volume in 1 second (r=-0·4662, p<0·001), and increased exacerbation frequency (p<0·0019; EMBARC cohort 1, n=197). AZU1 was associated with radiological severity (Reiff score), symptoms (quality of life bronchiectasis respiratory symptom score), and bacterial infection (sputum microbiology and 16S microbiome alpha diversity; highest levels of AZU1 were found in airway samples with Pseudomonas aeruginosa; p<0·0001; EMBARC cohort 2, n=144). Bronchiectasis patients with bacterial and viral exacerbations had increased concentrations of AZU1 (p=0·0003; n=96). These findings were extended to COPD, in which AZU1 was related to COPD severity (COPD cohort, n=101), and in patients with COPD challenged with rhinovirus A16, AZU1 was increased at day 9 post-challenge (p<0·001; n=9). In-vitro AZU1 impaired ciliary function and epithelial integrity, suggesting a mechanism by which AZU1 drives disease pathogenesis. In a post-hoc analysis of the WILLOW trial, AZU1 was the most downregulated protein with brensocatib treatment (brensocatib 10 mg, n=71; brensocatib 25 mg, n=73; and placebo, n=71). Over 24 weeks, AZU1 was significantly reduced by DPP1 inhibition (p<0·0001).</p><p><strong>Interpretation: </strong>AZU1 was identified as a novel marker of disease severity in bronchiectasis, associated with bacterial infection and exacerbation, and targeted by DPP1 inhibition.</p><p><strong>Funding: </strong>EMBARC3 and Insmed.</p>","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azurocidin-1 in neutrophilic airway disease: marker, mediator, or bridge to precision therapy?","authors":"Claudia Crimi, Raffaele Campisi","doi":"10.1016/S2213-2600(25)00474-6","DOIUrl":"https://doi.org/10.1016/S2213-2600(25)00474-6","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Children's respiratory health risks in the Gaza war: a call to act","authors":"Arietta Spinou, Nebal S Abu Hussein, Naftali Kaminski, Ahmed Al-Farra, Israel Amirav","doi":"10.1016/s2213-2600(26)00092-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00092-5","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"2 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147755111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive respiratory support improves outcomes in high-income countries","authors":"Elisabeth Riviello, Michael A Matthay","doi":"10.1016/s2213-2600(26)00078-0","DOIUrl":"https://doi.org/10.1016/s2213-2600(26)00078-0","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"67 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive respiratory supports and criteria for intubation in randomised trials of acute hypoxaemic respiratory failure: a systematic review and network meta-analysis.","authors":"Kevin G Lee, Madeline Hopkins, Rachel Couban, Thecla Kattakkayam, Peter M Reardon, George Tomlinson, Tyler Pitre, Bram Rochwerg, Christopher J Yarnell","doi":"10.1016/S2213-2600(26)00039-1","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00039-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with acute hypoxaemic respiratory failure (AHRF) can be treated with non-invasive respiratory supports. We aimed to update a network meta-analysis of these treatments, and investigate whether the use of criteria for intubation in trials influences treatment effects on intubation or mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this systematic review and meta-analysis, we updated a literature search that was done in 2022 for the previous network meta-analysis examining non-invasive oxygen supports for AHRF. We searched MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science, and PubMed databases from database inception to Nov 18, 2025, for randomised controlled trials studying adults (18 years or older) with AHRF, comparing non-invasive respiratory supports or comparing the use of non-invasive respiratory support to standard oxygen therapy (SOT). We excluded trials enrolling patients already receiving invasive ventilation, trials that included invasive ventilation as an intervention, trials where the majority (&gt;50%) of patients had congestive heart failure or chronic obstructive pulmonary disease as their primary reason for respiratory failure, and trials focusing on patients who were immediately postextubation or postoperative. Data were extracted from published reports. We catalogued intubation criteria and performed a network meta-analysis comparing the effects of continuous positive airway pressure (CPAP), high-flow nasal cannula (HFNC), and bilevel non-invasive positive pressure ventilation (NIPPV) on intubation and mortality, presented as odds ratios (ORs) and 95% credible intervals (CrIs) relative to SOT. We assessed risk of bias with the RoB 2 tool and certainty with the GRADE approach. We used network meta-regression to assess whether trials with intubation criteria found different treatment effects. The protocol was pre-registered on Jan 23, 2024, with Open Science Framework, https://osf.io/f8qeh.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We included 44 trials (33 from previous review, 11 newly identified) that enrolled 9704 patients. The median proportion of participants who were female was 37% (IQR 29-45) and the median proportion male was 63% (55-71). The network for intubation included 8790 patients and 42 comparisons from 37 trials. The network for mortality included 8789 patients and 39 comparisons from 34 trials. Intubation criteria were present in 37 (84%) trials, and most pertained to oxygenation, ventilation, or neurological state. Compared with SOT, CPAP (OR 0·45, 95% CrI 0·27-0·72), HFNC (OR 0·61, 0·42-0·86), and bilevel NIPPV (OR 0·60, 0·39-0·89) probably reduce intubation (all moderate certainty). CPAP (OR 0·73, 0·55-0·95) and HFNC (OR 0·83, 0·66-0·98) may reduce mortality compared with SOT (both low certainty), whereas bilevel NIPPV (OR 0·93, 0·71-1·17; low certainty) may not. Criteria for intubation were not associated with differences in treatment effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: ","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emulating target trials to study ICU interventions.","authors":"Juan Gago, Martin Urner, Eddy Fan","doi":"10.1016/S2213-2600(26)00053-6","DOIUrl":"https://doi.org/10.1016/S2213-2600(26)00053-6","url":null,"abstract":"","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":32.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}